7
Cutaneous Leishmaniasis (CL)
CL is the most common syndrome worldwide and the one most likely to be
encountered in patients in North America. Although autochthonous CL cases
acquired in Texas and Oklahoma have been reported, almost all of the cases of
CL evaluated in North America occur among immigrants, international travelers,
expatriates, and military personnel exposed in leishmaniasis-endemic areas elsewhere
in the world. The skin lesions typically are first noticed at the site(s) where Leishmania
parasites were inoculated by an infected sand fly. The lesions enlarge slowly and
typically ulcerate after weeks to months, although persistently nodular and other
forms also occur. The natural history is usually slow spontaneous healing as cell-
mediated immunity develops; healing may be accelerated with antileishmanial
treatment.
7. Tissue specimens should be collected from a lesion(s) when a
clinical suspicion for CL exists. Full-thickness skin biopsy specimens
allow for simultaneous testing for other diagnoses, such as by
histopathology and cultures (S-M).
8. Obtain a sample from a cleansed lesion, from which cellular debris
and eschar/exudates have been removed (S-VL).
9. Serologic testing is not recommended as part of the diagnostic
evaluation for CL. The currently available serologic assays are
neither sensitive nor specific for the diagnosis of CL (S-M).
Mucosal Leishmaniasis (ML)
Leishmania species with an increased risk of causing mucosal leishmaniasis (ML)
include L. (V.) braziliensis mainly, but also L. (V.) guyanensis and L. (V.) panamensis.
There are other species that can be associated with ML less frequently.
Amazonian-basin regions up to an altitude of approximately 2,000 meters are
increased-ML risk regions.
A minority of persons infected with L. (V.) braziliensis and related Viannia species in
Latin America, particularly in parts of South America, develop metastatic ML after
healing of CL or concomitantly with a cutaneous lesion(s). ML can progress to cause
destructive lesions of the naso-oropharyngeal/laryngeal mucosa. Leishmaniasis with
mucosal lesions also has been reported in the Old World, where the pathogenesis and
clinical manifestations of mucosal infection may be different.
10. The initial and most prominent mucosal manifestations typically
are nasal (eg, chronic unexplained congestion/secretions). Oral/
palatal, pharyngeal, and laryngeal involvement may develop as ML
progresses or, in some persons, may be the first or the only noted
abnormalities. The clinical signs, which may evolve over time, may
include erythema, edema, hyperemia, infiltration, nodules, erosion,
ulceration, and tissue destruction (eg, perforation of the nasal
septum) (FACT, no grade).
